Table 1 Demographic, baseline characteristics, clinical features and outcome of 319 episodes of Candida bloodstream infection in 262 pediatric patients.

From: Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

Patients demographics

No. (%) (total n = 262)

Microbiological characteristics (total n = 319 episodes)

No. (%) (total n = 319)

Age

 

Pathogens

 

  Non-neonatal patients (years), mean ± SD

6.7 ± 4.5

Candida albicans

148 (46.4)

  Neonatal patients (days), median (IQR)

22.5 (14.8–44.3)

Candida parapsilosis

86 (27.0)

Sex (male/female)

138 (52.7)/124 (47.3)

Candida tropicalis

18 (5.6)

Prematurity*

 

Candida glabrata

16 (5.0)

  Birth body weight (g), median (IQR)

1006.4 (740–1610)

Candida guilliermondii

12 (3.8)

  Gestational age (wks), median (IQR)

27.0 (25.0–31.5)

Other Candida spp.

39 (12.2)

Hospital days until diagnosis, median (IQR)

29.0 (15.0–53.0)

Source of BSI

 

Patients source

 

Primary

201 (63.0)

  Neonatal intensive care unit

94 (35.9)

Catheter-related BSI

70 (21.9)

  Pediatric intensive care unit

95 (36.3)

Abdominal

31 (9.7)

  Burn or surgical intensive care unit

10 (3.8)

Urologic

8 (2.5)

  General wards

63 (24.0)

Lung

4 (1.3)

Underlying chronic comorbidities#

 

Meningitis

5 (1.6)

  Congenital or genetic anomalies

28 (10.7)

Clinical presentation

 

  Neurological sequelae

89 (34.0)

Sepsis

307 (96.2)

  Cardiovascular disease

22 (8.4)

Severe sepsis

127 (39.8)

  Chronic lung disease and/or pulmonary hypertension

82 (31.3)

Septic shock

89 (27.9)

  Gastrointestinal sequelae

71 (27.1)

Progressive and deteriorated

61 (19.1)

  Renal sufficiency with/without dialysis

37 (14.1)

Disseminated candidiasis$

14 (4.4)

  Hematological/Oncology cancer

42 (16.0)

Duration of candidemia, median (range)

3.0 (1.0–32.0)

  Immunodeficiency

6 (2.3)

APACHE II score, mean ± SD

17.3 ± 4.2

  Autoimmune disease

7 (2.7)

Predisposing risk factors#

 

  Hepatic failure or cholestasis

12 (4.6)

Receipt of systemic antibiotics&

298 (93.4)

  Burn

5 (1.9)

Previous azole exposure&

34 (10.7)

  Others**

2 (0.8)

Prior bacteremia&

160 (50.2)

Case years

 

Presence of CVC

310 (97.2)

  2003–2006

82 (31.3)

Stay in an intensive care unit

244 (76.5)

  2007–2011

98 (37.4)

Receipt of parenteral nutrition

217 (68.0)

  2012–2015

82 (31.3)

Receipt of immunosuppressants

65 (20.4)

30-day all-cause mortality (from the first episode)

66 (25.2)

Artificial device other than CVC

160 (50.2)

  Within 72 hours without receiving antifungal therapy

9 (3.4)

Prior surgery&

99 (31.0)

  Early (>3 days, ≤7 days)

26 (9.9)

Neutropenia (ANC < 0.5 × 103/μL)

80 (25.1)

  Late (8–30 days)

31 (11.8)

Persistent BSI ≥ 72 hours of therapy

121 (37.9)

Overall final in-hospital mortality

92 (35.1)

Candida BSI attributable mortality

75 (23.5)

Clinical treatment failure

141 (44.2)

  1. *Only 94 patients from the neonatal intensive care unit.
  2. Defined as candidemia episodes with more disseminated candidiasis and/or progressive multi-organ failure even after effective antifungal agents.
  3. #Indicated the presence of underlying condition or risk factor at onset of Candida BSI, and most episodes occurred in patients with >1 underlying condition or risk factor.
  4. &Within one month prior onset of invasive candidiasis.
  5. **One patient had epidermolysis bullosa, and one patient had diabetes mellitus.
  6. $Indicated positive Candida isolates recovered from more than two sterile sites, in addition to primary bloodstream infection.
  7. APACHE II: Acute Physiology and Chronic Health Evaluation II score; BSI: bloodstream infection; ANC: absolute neutrophil count; CVC: central venous catheter; IQR: interquartile range; SD: standard deviation.
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